CITYWIDE INFANT MORTALITY RATE WAS 6.1 IN 2004, A DECLINE OF 6% FROM 2003

Racial and Ethnic Disparities Persist; DOHMH Interventions Focus on Communities with High Rates of Infant Mortality

NEW YORK CITY – September 8, 2005 – The infant mortality rate (IMR) – deaths of infants under one year old – decreased from 6.5 per 1,000 live births in 2003 to 6.1 in 2004 – a 6% decrease, according to preliminary data released today by the Department of Health and Mental Hygiene (DOHMH). The IMR in New York City is based on 760 infant deaths and 124,099 live births in 2004, a decrease from 807 infant deaths and 124,345 live births in 2003. New York City’s IMR is lower than the national average, which, according to preliminary national data, was 6.9 in 2003.

Infant mortality is influenced by many factors, including the mother’s health and socioeconomic status before, during and after pregnancy. The use of alcohol, tobacco or other drugs during pregnancy, and the accessibility and quality of health care services also contribute to infant mortality.

From 1989 to 2004, New York City’s IMR declined by 54%, from 13.3 to 6.1 per 1,000 live births. IMRs at the borough or neighborhood level are based on a relatively small number of infant deaths, and therefore year-to-year fluctuations may not reflect an actual trend. It is most meaningful to look at the changes in IMR over multiple years (For a full table of births, deaths and IMR’s by year, visit http://www.nyc.gov/html/doh/downloads/pdf/public/press05/imr3-05.pdf).

In 2004, similar to recent years, very low birth weight (VLBW) infants - those who weigh less than 1,500 grams (3 pounds, 5 ounces) at birth - accounted for more than half (57%) of infant deaths but only 1.7% of total births. Nearly 90% of deaths among infants under 1,500 grams were among those who weighed less than 1000 grams (2 pounds, 3 ounces). Virtually all VLBW infants are born prematurely and had much higher rates of infant mortality (205 per 1,000 in 2004) than normal birth weight infants (1.5 per 1,000).

Infant Mortality Rates by Race/Ethnicity and Borough

While much progress has been made, significant race/ethnic disparities in IMR persist. The IMR among black infants was 11.6 per 1,000 in 2004 and 7.5 among Puerto Rican infants.

Infant mortality rates vary by borough, with higher rates in New York City’s poorest neighborhoods. IMRs for Brooklyn and the Bronx remain higher than the City average, although the Bronx showed a decrease this year (8.6 in 2003 to 7.1 in 2004). A full table of IMR by neighborhood is available online at http://www.nyc.gov/html/doh/downloads/pdf/public/press05/imr-05.pdf.

2004 IMR in NYC - by Borough

NYC (overall)

6.1

Brooklyn

6.6

Bronx

7.1

Manhattan

4.2

Queens

5.4

Staten Island

5.0

Highest IMRs – Brownsville, Brooklyn had the highest IMR in the City (12.2). Other neighborhoods with high IMRs included Jamaica East, Queens (10.1) and Pelham Bay in the Bronx (9.0).

Lowest IMRs – Neighborhoods with the lowest IMRs were Kips Bay-Yorkville (1.9) and the Lower West Side (2.4) in Manhattan, Flushing, Queens (2.9) and Williamsburg-Greenpoint, Brooklyn (3.2).

"While overall rates have decreased, several communities account for a disproportionate share of infant deaths,” said DOHMH Commissioner Thomas R. Frieden, MD, MPH. “And, as in previous years, the rates for Black and Puerto Rican infants were higher than other groups. We are working closely with medical and community partners to reduce persistent disparities, promote women’s control over their reproductive choices, including access to emergency contraception, increase drug-free pregnancies, promote breastfeeding, and increase the number of infants put ‘back to sleep’ to reduce Sudden Infant Death Syndrome (SIDS).”

Multiple Births Increase in New York City

Over the past ten years, multiple births (e.g. twins) increased from 3% to 4% of births. The largest increase in multiple births was among older women (over 40 years of age), likely due to the increase in assisted reproductive technologies. While multiples have a higher risk of mortality and are becoming more common, they account for a small proportion of infant deaths.

Have a Healthy Baby – a Take Care New York Priority

Since 1989, there have been several notable improvements in maternal and infant health. These include a 32% decrease in births to teenagers, a 23% increase in prenatal care in the first six months of pregnancy, and a 37% increase in Medicaid coverage to women who gave birth.

As part of its Take Care New York health policy, DOHMH is aiming to reduce New York City’s IMR to below 5.0 by 2008. DOHMH works with government, community and hospital-based providers, academic institutions, and other organizations to establish infant and maternal health programs in neighborhoods that have the highest infant mortality rates. Ongoing and expanded activities of DOHMH with its community partners to reduce infant and maternal mortality and unintended pregnancy include:

On April 21, 2005, Mayor Michael R. Bloomberg announced the allocation of $3 million to launch the Healthy Women/Healthy Babies Initiative, a comprehensive program to improve the health of women and infants and reduce unintended pregnancies. Key components of the initiative are:

An education and outreach campaign for community-based and health care organizations to increase awareness of and access to emergency contraception.

Visits by DOHMH health educators to primary care providers to distribute educational tools, resources, and other materials on contraception, including emergency contraception.

Launch of the Family Planning Initiative to identify gaps in family planning and reproductive health services and increase access to contraception, including emergency contraception.

In July 2005, DOHMH, SCO Family of Services, and Bedford-Stuyvesant Family Health Center were awarded a $1.35 million annual federal Healthy Start Brooklyn grant to reduce infant mortality and improve maternal/child health in Bedford-Stuyvesant and Brownsville, Brooklyn, which have had infant mortality rates nearly double the City’s average.

In 2004, DOHMH launched its Newborn Home Visiting Program, in which staff visit first-time mothers soon after delivery. It currently operates in East and Central Harlem and Bushwick and Bedford-Stuyvesant in Brooklyn, where infant mortality rates exceed the City average. DOHMH staff educate mothers about breastfeeding and SIDS risk reduction, and conduct an environmental assessment to prevent lead poisoning and promote home safety.

The Nurse Family Partnership is a comprehensive evidence-based nurse home visiting program for low income, first-time mothers, which began operating in New York City in July 2003. Due to a substantial increase in private and public support in 2004, the program served approximately 176 families at risk, more than three times the number served in 2003. Currently, this program operates in East Jamaica Queens, East and Central Harlem, and Central Brooklyn, and enrollment of families in the South Bronx is planned for 2006.

Established in 2003, the Harlem Strategic Action Committee on Infant and Maternal Mortality addresses the disparities in maternal and infant health outcomes in Central Harlem. A collaboration between DOHMH, HHC, the City Council, community based providers, and advocacy groups, the Committee coordinates activities including medical education for providers, social networking programs for pregnant women, parenting skills, breastfeeding promotion, and media campaigns on male involvement and post-partum depression.

DOHMH convenes the Citywide Infant Mortality Case Review Committee, which reviews and analyzes infant deaths and makes recommendations for program and policy interventions to reduce the risk of infant mortality.

The mother’s health before, during and after pregnancy may impact the infant’s risk of illness or death. The DOHMH convenes a Maternal Mortality Review Committee to conduct ongoing surveillance of maternal mortality, and to identify preventable causes of death and design appropriate responses.

The Infant Mortality Reduction Project, funded by the City Council, works to strengthen the infrastructure, capacity, and effectiveness of community-based organizations and services to reduce infant mortality through health education workshops, outreach, referral services, case management and other activities.

The Department appreciates the dedicated community based organizations, public officials, advocates, hospitals, and providers actively engaged in other important community-based and Citywide efforts to prevent infant and maternal mortality. Call 311 and ask for women's health information or visit http://www.nyc.gov/health/maternity for more information on maternal, infant and reproductive health.